Genital abnormalities in white-tailed deer (Odocoileus virginianus) in west-central Montana: pesticide exposure as a possible cause

From spring, 1996, to early spring, 2000, accident-killed and injured white-tailed deer, Odocoileus virginianus, in the Bitterroot Valley of west-central, Montana, U.S.A., were collected and examined for genital abnormalities at the Bitterroot Wildlife Rehabilitation Center. Of the 254 male deer examined, 133 were fawns aged 3 months to 1 yr, 29 were 1 to 1 1/2 yrs of age, and 92 were 1 1/2 to 3 yrs of age. Approximately 33% were normal; the remaining 67% showed varying degrees of apparent genital developmental anomalies, specifically mispositioned and undersized scrota and ectopic testes, and this percentage held through all age groups. The sex ratio of fawns and fetuses was skewed towards males, significantly so for the 1996 fawn cohort and for the total of all fawns and fetuses in the study. Although possible causes of the genital anomalies, centering on endocrine disrupting pesticides, are discussed, no conclusions of cause and effect can be currently justified.

Sonographic detection of undescended testes in the third trimester

OBJECTIVE

To assess the sonographic detection rate of fetal undescended testes among a low-risk population during the third trimester.

METHODS

A sonographic evaluation, which included biometric studies and a detailed examination of the fetal genitalia, was performed prospectively on 332 male fetuses of singleton pregnancies between 34 and 40 weeks' gestation. A qualified neonatologist examined the presence of the testes within the scrotum within 3 days after birth.

RESULTS

The scrotum was visible in 294 (89%) of the 332 fetuses who were examined. It was visible in all fetuses evaluated between 34 and 36 weeks' gestation. Nine cases of undescended testes were detected (3%). Of these, the diagnosis of 1 case, examined at 34 weeks' gestation, was revealed after birth to be false-positive. There were no false-negative results.

CONCLUSIONS

Sonographic examination during the late third trimester of pregnancy appears to allow accurate diagnosis of undescended testes prenatally. This early identification will alert the neonatologist of the possibility of cryptorchidism and will permit early postnatal identification and treatment.

One-stage correction of proximal hypospadias and penoscrotal transposition

BACKGROUND AND PURPOSE

Total correction of proximal hypospadias and penoscrotal transposition (PST) is a challenge to surgeons. Staged operation is usually recommended because the blood supply to the neourethra or the skin covering the penile shaft may be severed during scrotoplasty. This paper describes results obtained using a new technique for total correction, which preserves the blood supply to the neourethra in a one-stage operation.

PATIENTS AND METHODS

Between July 1998 and March 2000, five boys (mean age 4 yr) with proximal hypospadias and PST underwent total correction in a one-stage operation. The urethral meatus of these patients was located at mid shaft in one, at the penoscrotal junction in two, and at the scrotum in two. Hypospadias was repaired using the Snodgrass procedure and PST was corrected using the Ehrlich and Scardino technique. Radical bulbar urethra dissection and tunica albugineal plication were used to correct penile curvature in all five cases. The urethral stent was removed on the seventh or eighth postoperative day. The meatus was then dilated using the cone tip of an ophthalmic ointment tube two or three times per day for 2 to 4 weeks. Postoperative urinary flow was observed in the outpatient clinic.

RESULTS

The mean follow-up period was 11.2 months. There was no postoperative fistula. One patient had postoperative meatal stenosis that was successfully treated by dilation. Postoperatively, the penile base was well above the scrotal rhugae and the meatus was at the tip of the glans in each patient. The postoperative urinary flow was straight in all patients.

CONCLUSION

Combining Snodgrass hypospadias repair and Ehrlich and Scardino PST repair in a one-stage operation preserved the blood supply to the neourethra and achieved excellent functional and cosmetic results.

Penoscrotal transposition: review of 53 patients

PURPOSE

Penoscrotal transposition is a rare congenital abnormality of the external genitalia. We determine whether there is a genetic basis for this disorder, define the incidence of coexisting organ system anomalies, and compare the results of surgical techniques to correct transposition and hypospadias.

MATERIALS AND METHODS

We report the largest, single institution series of 53 patients 1 day to 30 years old with penoscrotal transposition.

RESULTS

Of the patients 13% had a family history of penoscrotal transposition. Interestingly, we identified 1 family in which inheritance occurred in an X-linked recessive manner. There were 17 (32%) patients who had abnormalities in other organ systems, with the genitourinary system in 9 affected most. A total of 79% of patients had hypospadias and 81% chordee. These anomalies were corrected with a single stage Thiersch-Duplay urethroplasty in 6 patients and complex repair with bladder or buccal mucosa, or a staged procedure in 34. Complication rates for urethroplasty were similar. Correction of the transposition included a Glenn-Anderson technique in 37 patients, Singapore rotational flaps in 7 and V-Y procedure in 6. The Glenn-Anderson repair produced the best cosmetic results and was associated with a significantly lower incidence of complications (p = 0.001).

CONCLUSIONS

We identified a subgroup of patients with a family history of penoscrotal transposition. Treatment requires an awareness of the association with other organ system anomalies. The Glenn-Anderson technique was the most successful method to correct transposition. Most patients required release of chordee and complex urethroplasty for hypospadias.

A case of del(13)(q22) with multiple major congenital anomalies, imperforate anus and penoscrotal transposition

"13q-"syndrome is known to have widely variable manifestations, including retinoblastoma, mental & growth retardation, malformation of brain & heart, anal atresia, and anomalies of the face and limbs. Here we report a case of del(13)(q22) with multiple major congenital anomalies for the first time in Korea. The patient was born at 36(+4) weeks of pregnancy by caesarian section. Birth weight was 1490g. On examination the following features were noted: - imperforate anus, ambiguous genitalia (bifid scrotum, penoscrotal transposition, hypospadia), syndactyly of toes, absence of thumbs, abnormal facies (dolichocephaly, telecanthus, large low set ears, saddle nose, high arched palate, micrognathia). Neurocranial ultrasonography showed atrophy of the corpus callosum and multiple calcifications. He died at 14 days. Post-mortem autopsy findings showed cholestasis and fatty metamorphosis of liver, abnormal lobulation (Rt:2, Lt:1) and lymphangiectasis of the lung, VSD, ASD, PDA of heart, and acute tubular necrosis of kidney. Cytogenetic studies was confirmed to 46,XY,del(13) (q22) by Giemsa banded chromosomes from peripheral blood lymphocytes.

Magnetic resonance imaging in the evaluation of congenital anomalies of the external genitalia

OBJECTIVES

To assess the value of magnetic resonance imaging (MRI) in the anatomic evaluation and management planning of complex congenital genitourinary anomalies.

METHODS

Multiplanar T(1) and T(2)-weighted MR images were obtained in 6 pediatric patients with congenital genitourinary anomalies, including aphallia, diphallia, ectopic scrotum, and epispadias. The imaging studies were read by experienced radiologists and discussed with the urologic surgeons in a multidisciplinary conference.

RESULTS

Each congenital anomaly was demonstrated in detail by MRI. The MR images of penile agenesis showed hypoplastic corpora cavernosa and a vestigial bulb. In patients with penile duplication, MRI was able to delineate the course of each corporal body and the varying degree of thickness of the tunica albuginea. For the patient with scrotal ectopia, detailed MR images excluded both the possibility of urethral and corporal duplications and the presence of viable testes in the ectopic scrotum. In the case of epispadias, MRI illustrated the precise spatial relationship between the erectile bodies and urethra. Additionally, MRI identified related aberrant pelvic organs and provided images of the external genital structures.

CONCLUSIONS

MRI, by rendering excellent anatomic interpretation of complex genital anomalies and associated abnormal pelvic tissues, assists surgeons in conceptualizing the anomalous structures and contributes to their formulation of management approaches.

Two cases of pseudoduplication of the external genitalia

In two newborn boys an accessory rudimentary phallus and scrotal sacs were present on the surface of a midline perineal swelling. Both boys had an associated high anorectal anomaly (ARA), a small phallus, and a bifid scrotum with absence of the scrotal raphé. One also had penile torsion with hypospadias and an accessory anal dimple. During definitive surgery for the ARA in one patient, excision of the perineal soft-tissue mass and overlying duplicated penoscrotal tissue was performed. The embryogenesis of this condition is discussed.

Evidence for the "midline" hypothesis in associated defects of laterality formation and multiple midline anomalies

A male infant was liveborn at 38 weeks of gestation to a G4P1AB2, 22-year-old, mother. Polyhydramnios and multiple congenital anomalies were noted by ultrasonography; the infant died 5 min after birth. At autopsy, the infant had multiple defects of blastogenesis including midline anomalies with asplenia and abnormalities of laterality formation. The laterality defects were unusual in that they combined asplenia with hypoplastic, symmetrically unilobate lungs and bilateral hyparterial bronchi more consistent with polysplenia, abdominal situs inversus with midline stomach, symmetric liver, and left gallbladder. No intracardiac abnormalities were present, but there was azygous continuation of the inferior vena cava. Additional multiple midline defects included bronchoesophageal fistula, duodenal atresia, absence of posterior leaf of diaphragm; horseshoe adrenal gland; microcephaly; Dandy-Walker anomaly with agenesis of cerebellar vermis and occipital encephalocele; holoprosencephaly with orbital encephalocele, midline defect of the orbital plate of the skull, bilateral anophthalmia, double proboscis with bilateral choanal atresia, midline upper lip and palatal cleft; single-lobed thyroid; hypoplastic external genitalia with midline cleft of scrotum, long tapering fingers, and defects of the cranium at the sites of orbital and occipital encephaloceles. Defects of laterality frequently are associated with other complex midline anomalies, which both result from a disturbance of pattern formation during blastogenesis, i.e., the induction of the progenitor fields. The latter are the result of the establishment of upstream expression domains of growth and transcription factors and other morphogens. Many of these and other genetic systems, expressed asymmetrically around the midline, are responsible for laterality formation and are the result of upstream and subsequent downstream gene expression cascades through the expression of genes such as HOX genes; bFGF; transforming growth factor beta/activins/BMP4; WNT-1,8; and SHH.

Caudal Regression Syndrome and peno-scrotal transposition

Caudal Regression Syndrome is a rare anomaly affecting different systems in the caudal portion of the fetus. Peno-scrotal transposition is a rare condition of variable severity often associated with Caudal Regression Syndrome. We report a case of Caudal Regression Syndrome with perineal ano-rectal duplication, incomplete peno-scrotal transposition, perineal hypospadias, chordee, and thoracic hemivertebrae.

Syndrome of short stature, widow's peak, ptosis, posteriorly angulated ears, and joint problems: exclusion of the Aarskog (FGD1) gene as a candidate gene

A syndrome encompassing postnatal onset of short stature, widow's peak, ptosis, posteriorly angulated ears, and limitation of forearm supination is reported in a boy and his mother. The boy has not yet experienced dislocation of patella or other joint anomaly except for limitation of supination of the forearms. On the other hand, the mother has a milder limitation of supination only on the left arm and is devoid of ptosis. Their condition is reminiscent of that described in the family reported by Kapur et al. [1989: Am. J. Med. Genet. 33: 357-363.], which showed an X-linked dominant mode of inheritance. DNA study on our family using an intragenic polymorphism of the Aarskog syndrome (FGD1) gene and four other adjacent markers convincingly excludes the possibility that their condition could be caused by a mutation of the FGD1 gene. Our family and the family reported by Kapur et al. may suggest segregation of a novel X-linked dominant condition.

Agenesis of the scrotum

Congenital agenesis of the scrotum skin is an extremely rare disorder with only two cases previously reported. We report a newborn with scrotal agenesis and congenital hypothyroidism.

Idiopathic congenital dysmorphic megascrotum

An enlarged scrotum in the pediatric population constitutes a relatively frequent physical finding requiring evaluation. Most cases of scrotomegaly have a clearly identifiable etiology. We present a patient with an idiopathic congenital dysmorphic megascrotum.

Sexual development in marsupials: genetic characterization of bandicoot siblings with scrotal and testicular maldevelopment

In marsupials testis determination requires the presence of a Y chromosome. The sex determining region on the Y gene (SRY) is necessary for testicular development in eutherians and it is assumed to play a similar role in marsupials. Relatively few studies have investigated the genetic basis of sexual development, and as yet there is no direct evidence that SRY is required for testis development in marsupials. Studies on intersexual marsupials have revealed a fundamental difference between marsupial and eutherian sex determination. The scrotum of marsupials is analogous, not homologous, to the eutherian scrotum and is under the control of X-linked genes not androgens. The current study describes two bandicoot (Isoodon macrourus) siblings. Both siblings had underdeveloped male reproductive tracts and testicular dysgenesis, one was ascrotal and the other had a diminutive scrotum. Their karyotypes were normal for this species which eliminates the Y chromosome from some somatic tissues. SRY was detected by Southern blotting. SRY, ubiquitin activating enzyme-1 on the Y (UBE1Y) and glucose 6-phosphate dehydrogenase (G6PD) gene expression were examined. UBE1Y was widely expressed in many tissues. SRY gene expression was much lower than normal in the abnormal siblings and may be responsible for their failure of testicular and epididymal development. The cause of their scrotal abnormalities is unknown. It is possible that the separate defects of scrotal and testis development in the two siblings, which had normal relatives, were due to a mutation in a gene common to both developmental pathways.

Correction of penoscrotal transposition: a novel approach

PURPOSE

Penoscrotal transposition is a rare anomaly resulting in a partial or complete positional exchange between the penis and the scrotum. Time-honored repairs of penoscrotal transposition rely on the creation of rotational flaps to mobilize the scrotum. We offer a radically different approach to this anomaly by transposing the penis and not the scrotum to its normal anatomical location.

MATERIALS AND METHODS

Transposition of the penis was performed in 15 patients. The penis is degloved followed by correction of the chordee. A suprapubic buttonhole is created in an anatomically correct location for the penis. The degloved phallus is then delivered into this buttonhole. The shaft skin is mobilized and transposed to resurface the penile shaft. A midline scrotoplasty completes the first stage. The scrotum is never transposed and scrotal rotational flaps are unnecessary.

RESULTS

All 15 patients have had an excellent cosmetic outcome. There have been no cases of vascular compromise to the shaft or scrotal skin.

CONCLUSIONS

This novel approach produces superior cosmetic results and should be used in all cases of penoscrotal transposition.

Genitopatellar syndrome: a new condition comprising absent patellae, scrotal hypoplasia, renal anomalies, facial dysmorphism, and mental retardation

We report on the association of absent patellae, genital and renal anomalies, dysmorphic features, and mental retardation in seven children (six boys and one girl) belonging to five unrelated families. Flexion deformities of the knees and hips with club feet and absent patellae were consistently observed and scrotal hypoplasia and cryptorchidism were present in all boys (6/6). Dysmorphic features included a coarse face, a large nose with a high nasal bridge, and microcephaly. Other features included renal anomalies (multicystic kidneys or hydronephrosis, 7/7), agenesis of the corpus callosum (4/7), swallowing difficulties, micrognathia (4/7), and pulmonary hypoplasia (3/7). Bilateral hypoplasia of the ischia and brachydactyly were also consistently observed (5/5). In two out of seven cases, prenatal ultrasound detection of microcephaly and renal anomalies led to termination of the pregnancy at 27 weeks. Three children died during the first years of life and the remaining two who survived exhibit severe developmental delay. High resolution cytogenetic studies performed on lymphocytes or fibroblasts or both were normal in all cases. Recurrence in two families suggests an autosomal recessive mode of inheritance. We propose that this unusual association, similar to that observed in a 4 year old boy by Goldblatt et al, represents a new syndrome distinct from previously reported hypoplastic patella syndromes.

Accessory scrotum

A 2-year-old male with a perineal swelling, covered with normal skin without any rugosities, was diagnosed as having an accessory scrotum on histopathology. There was no other congenital anomaly. The case is reported due to its rarity and unique clinical picture.

[Scrotal hypospadias. Our experience with free oral mucosa grafts]

Many surgical techniques, using different tissues, have been performed to repair the scrotal hypospadias in this century, but none of them has been completely effective. The use of autologous buccal mucosa as a free graft for urethral replacement was introduced in 1989. The reported results have been encouraged since then. Twenty three patients with scrotal hypospadias, have been treated from 1991 to 1998. These patients underwent a 2-stage surgical replacement. The first stage of the procedure included correction of the penile curvature and advancement of preputial flaps ventrally as described by Byras. The second stage of the procedure was the urethroplasty. The neourethra was made of a tubularized buccal mucosa graft. The mucosa was harvested from the inner surface of the lower lip. The first stage was performed at a mean age of 20 months old, and the second stage at a mean age of 32 months old. Micropenis was detected in 26% of patients. All of them were treated with topic testosterone before the second stage. The follow-up reflected that 7 out of 23 patients (30.4%) had not complications, while 16 patients (69.5%) developed urethro-cutaneous fistula. Six of them (26%) required only one surgical closure and the other 10 patients required more than one surgical procedure to correct several complications. One patient presented complications in both the recipient and the donor areas. Nowadays, cosmetic and functional results are good in 22 patients.

Penoscrotal inversion, hypospadias, imperforate anus, facial anomalies, and developmental delay: definition of a new clinical syndrome

We describe a 2-month-old boy with penoscrotal inversion, hypospadias, imperforate anus, facial anomalies, developmental retardation, and a subtelomeric deletion of chromosome 13q. His phenotype with anogenital malformations and characteristic facies closely resembled two unrelated patients with minute deletions of chromosome 13q who we reported earlier. In addition, he had unilateral renal agenesis. We propose that these patients represent a clinically recognizable, novel chromosomal microdeletion syndrome. The findings indicate the presence of a major gene(s) on chromosome 13q33.2qter that regulate(s) the migration and development of ano-reno-genital cells and organs. We speculate that mutations of this developmental gene(s) may also result in more frequent congenital malformations (isolated hypospadias, uterus bicornis, unilateral renal agenesis). Additional studies are needed to further delineate the genetic defect.

Facio-genito-popliteal syndrome presenting with bilateral choanal atresia and maxillary hypoplasia

The most classic characteristics of facio-genito-popliteal syndrome are cleft lip and/or palate, anomalies of the external genitalia and popliteal pterygium. A case of facio-genito-popliteal syndrome with bilateral choanal atresia and maxillary hypoplasia is presented. No previous report of such an association was found in the literature.